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Year 3 - General Practice > Primary Care ENT > Flashcards

Primary Care ENT Flashcards

1
Q

What is Benign Paroxysmal Positional Vertigo?

A

One of the most common causes of vertigo characterised by sudden onset dizziness exacerbated by a change in head position.

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2
Q

At what age does BPPV usually occur?

A

Average age is around 55 years old.

It doesn’t occur often in younger patients.

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3
Q

How long do episodes usually last in patients with BPPV?

A

10 to 20 seconds.

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4
Q

What manoeuvre can be performed to diagnose BPPV?

A

Dix-Hallpike manouvre - turn the patients head 45 degrees whilst they are seated and lie the patient back abruptly extending their neck over the bed around 20 degrees. A positive test is where a patient will have Nystagmus.

Do the same on the other side.

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5
Q

What manoeuvre will treat the BPPV?

A

The Epley manoeuvre

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6
Q

What is the management for BPPV?

A

Exercises at home that they will need to do everyday which is known as vestibular rehabilitation.

Eg. Brandt-Daroff exercises.

Betahistine can be prescribed but it is of limited value.

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7
Q

What is Menieres disease?

A

It is a disorder of the inner ear of unknown cause.

It is characterised by excessive pressure and progressive dilation of the end-lymphatic system.

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8
Q

How does Menieres present?

A

Vertigo

Tinitus

Sensorineural hearing loss

Sensation of aural fullness/pressure

Nystagmus

Positive Rhomberg’s test

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9
Q

How should you manage Menieres disease?

A

ENT referral for confirmation of diagnosis

Acute attacks: buccal/IM Prochlorperazine. Admission is sometimes required.

Prevention: Betahistine and vestibular rehabilitation exercises.

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10
Q

What are the most common causes of Otitis Externa?

A

Infection (Staphylococcus aureus, Pseudomonas. aeruginosa) or fungal infection

Seborrhoeic dermatitis

Contact dermatitis

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11
Q

How does Otitis Externa appear on Otoscopy?

A

Eczematous, erythematous swollen ear canal.

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12
Q

How would you manage Otitis Externa?

A
  • Topical antibiotic or combined topical antibiotic with a steroid.
  • Oral antibiotic if the infection appears to be spreading (eg. Flucloxacillin PO)

If the patient doesn’t respond to topical antibiotics then refer to ENT.

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13
Q

What is Malignant Otitis Externa?

A

Infection in the soft tissues of the external auditory meatus that often presents its self in immunocompromised individuals (90% are diabetics) commonly caused by Pseudomonas aeruginosa.

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14
Q

What can Malignant Otitis Externa progress to?

A

Temporal bone osteomyelitis

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15
Q

How does Malignant Otitis Externa present?

A

Otalgia

Temporal headaches

Purulent Otorrhoea

Dysphagia/hoarseness/facial nerve dysfunction

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16
Q

How do you diagnose Malignant Otitis Externa?

A

Order a CT scan

17
Q

What is Otitis Media? What patients does it usually affect?

How does this appear on Otoscopy?

A

Infection in the middle ear. It usually affects young children 6-18 months.

Erythematous tympanic membrane that appears bulging.

18
Q

Most common bacterial causes of Otitis Media?

A

Streptococcus. pneumoniae

Haemophilus. influenza

Moraxella. catarrhalis

19
Q

When should you prescribe antibiotics in Otitis Media?

A

If the condition has lasted longer than 4 days or is not improving

If the patient is systemically unwell

Patient <2 years old with bilateral acute Otitis Media.

Perforation or discharge in the canal

20
Q

What is suppurative Otitis Media?

A

This is where there is an effusion as a result of a chronic infection.

21
Q

What is Otosclerosis?

A

This is where the Stapes fuses to the oval window and results in a progressive conductive hearing loss.

22
Q

What is Cholesteatoma and how is it managed?

A

A non cancerous growth of the squamous epithelium that is trapped within the skull base leading to local destruction. Most common in patients 10-20 years old.

Presents with foul smelling non resolving discharge and hearing loss.

can also present with vertigo and facial nerve palsy dependent upon the extent of the invasion.

23
Q

What is a complication of acute otitis media?

A

Mastoiditis

Meningitis (rarely)

24
Q

What is Mastoiditis?

How does it present?

A

Inflammatory process within the mastoid bone.

It can present as an otalgia (behind the ear). Fever. Swelling and erythema around the mastoid process.

Ear discharge may present.

25
Q

What is Ramsay-Hunt Syndrome?

A

Reactivation of the Varicella. zoster virus in the geniculate ganglion of the 7th cranial nerve.

26
Q

What are the most common causes of acute sinusitis?

A

Streptococcus. pneumoniae

Haemophilus. influenzae

Rhinoviruses

27
Q

How does acute sinusitis present?

A

Facial pain that is worsened on leaning forward.

Thick and purulent nasal discharge

Nasal obstruction

28
Q

How do you manage acute sinusitis?

A

Analgesia

Intranasal decongestants/intranasal saline - limited evidence

Consider nasal corticosteroids when symptoms persist for longer than 10 days

Antibiotics are indicated in patients that are systemically unwell but are not often used.

29
Q

How does allergic rhinitis present?

A

Sneezing

Bilateral nasal obstruction

Post-nasal drip

Clear nasal discharge

Nasal pruritus

30
Q

How do you manage allergic rhinitis?

A

Mild to moderate: oral or intranasal antihistamines

Moderate to severe: intranasal corticosteroids

A short course of oral corticosteroids can be used for important life events

31
Q

What is chronic rhinosinusitis?

A

Inflammatory disorder of the paranasal sinuses and linings of the nasal passages that take 12 weeks or longer.

32
Q

How do you manage chronic rhinosinusitis?

A

Avoid allergen

Intranasal corticosteroids

Nasal irrigation with saline solution

33
Q

Name some causes of tinnitus?

A

Otosclerosis

Drugs - eg. NSAID’s, Aspirin and Quinine

Acoustic neuroma

Presbyacusis

34
Q

What topical treatment should be prescribed for uncomplicated acute otitis external?

A

Acetic acid 2% spray

35
Q

What are the indications for a Tonsillectomy

A

More than 5 episodes in one year

The symptoms are disabling and prevent normal functioning

Sore throats are due to tonsillitis

If the patient suffers with febrile seizures resultedly

If the patient suffers with dysphagia, stridor and sleep apnoea

Year 3 - General Practice (10 decks)

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